Trochanteric nail with locking opening

ABSTRACT

A trochanteric nail for insertion in an intramedullary canal of a bone for treating bone fractures. The nail may include an elongate body having a head portion and a stem portion. One or more openings may be provided in the head portion for receiving an anchoring member, such as a bone screw, for fastening the nail within the bone. An intermediate opening may also be provided in the stem portion for receiving an anchoring member. A distal area of the nail may include or be free from anchoring members. In addition, a set of nails may be provided with each nail of the set of nails having a different length in which the intermediate opening is the same distance from the proximal end for each nail.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.11/773,029 filed on Jul. 3, 2007. This application claims the benefit ofU.S. Provisional Application No. 60/818,734, filed Jul. 5, 2006.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present disclosure relates generally to bone treatment devices, andmore particularly, but not necessarily, to trochanteric nails forstabilizing bone fractures.

2. Description of Related Art

Intramedullary nails are proven devices that provide a temporaryfixation means to stabilize a fracture until the fracture heals. Thenail is inserted in the marrow canal of the bone and is positioned tospan the fracture. The nail is anchored within the bone via bone screwsplaced through aligned apertures in the nail as received in the bone.The screws are usually inserted in the proximal and distal ends of thenail, and the orientation of the screws depends upon the particularfracture configuration and the type of long bone fracture, i.e., femur,tibia, humerus.

Intramedullary nails may offer distinct advantages over other methods offixation. For example, intramedullary nails may help bones heal faster,with lower rates of infection as compared to other surgical methods offixation. Moreover, improved early mobilization of limbs having thebroken bone may be achieved. One of the significant improvements overother methods of fixation is that intramedullary nails may share loadswith the bone, rather than entirely supporting the bone across thefracture site. Because of this, patients may be able to move the brokenlimb sooner than they would with traditional casting of the bone. Thismay help maintain more strength of the muscles and prevent frozenjoints, where joints become stiff after prolonged casting.

A drawback of some of the known intramedullary nails is that it may bedifficult to install the bone screws into the apertures in the nail tofix the intramedullary nail in place. Surgeons are often required toplace the bone screws through the apertures in the intramedullary nails,particularly apertures in the distal end of the nail, without the use ofa guide jig.

The features and advantages of the disclosure will be set forth in thedescription which follows, and in part will be apparent from thedescription, or may be learned by the practice of the disclosure withoutundue experimentation. The features and advantages of the disclosure maybe realized and obtained with the instruments and combinationsparticularly pointed out in the appended claims.

SUMMARY OF THE INVENTION

A trochanteric nail for insertion in an intramedullary canal of a bonefor treating bone fractures. The nail may include an elongate bodyhaving a head portion at a proximal end and a stem portion toward adistal end. One or more openings may be provided in the head portion forreceiving an anchoring member, such as a bone screw, for fastening thenail within the bone. An intermediate opening may also be provided inthe stem portion for receiving an anchoring member. A distal area of thenail may be free from anchoring members. The nail may be provided as oneof a set of nails having different lengths in which the intermediateopening is the same distance from the proximal end in each of the nails.Accordingly, a guide may be used to install the anchoring member in theintermediate opening.

Further areas of applicability of the present invention will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating the preferred embodiment of the invention, are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the disclosure will become apparent froma consideration of the subsequent detailed description presented inconnection with the accompanying drawings in which:

FIG. 1 is a schematic view of a known trochanteric nail of a longvariety in a femur;

FIG. 2 is a schematic view of a known trochanteric nail of a shortvariety in a femur;

FIG. 3 is a schematic view of a trochanteric nail in a femur inaccordance with the principles of the present disclosure;

FIG. 4 is an alternative embodiment of a schematic view of atrochanteric nail in a femur in accordance with the principles of thepresent disclosure;

FIG. 5 is a break-away side view of one embodiment of a nail inaccordance with the principles of the present disclosure;

FIG. 6 is a break-away top view of the nail of FIG. 5 with portions ofthe nail shown in cross-section;

FIG. 7 is a proximal end view of the nail of FIG. 5;

FIG. 8 is a cross-sectional view of the nail of FIG. 5 taken along line7-7;

FIG. 9 is a break-away top view of the nail of FIG. 5 showing a bend inthe nail;

FIG. 10 is a break-away side view of the nail of FIG. 5 showing a bendin the nail; and

FIG. 11 is a break-away top view of the left nail.

FIG. 12 is a break-away top view of an embodiment of the nail of FIG. 5showing a bend in the nail with the distal area free of openings.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following description of the preferred embodiment(s) is merelyexemplary in nature and is in no way intended to limit the invention,its application, or uses.

For the purposes of promoting an understanding of these principles inaccordance with the disclosure, reference will now be made to theembodiments illustrated in the drawings and specific language will beused to describe the same. It will nevertheless be understood that nolimitation of the scope of the disclosure is thereby intended. Anyalterations and further modifications of the inventive featuresillustrated herein, and any additional applications of the principles ofthe disclosure as illustrated herein, which would normally occur to oneskilled in the relevant art having possession of this disclosure, are tobe considered within the scope of the disclosure claimed.

Before the present apparatus and methods for treating a bone fractureare disclosed and described, it is to be understood this disclosure isnot limited to the particular configurations, process steps, andmaterials disclosed herein as such configurations, process steps, andmaterials may vary somewhat. It is also to be understood that theterminology employed herein is used for the purpose of describingparticular embodiments only and is not intended to be limiting since thescope of the present disclosure will be limited only by the appendedclaims and equivalents thereof.

As used in this specification and the appended claims, the singularforms “a”, “an”, and “the” include plural referents unless the contextclearly dictates otherwise. Moreover, as used herein, the terms“comprising”, “including”, “containing”, “characterized by” andgrammatical equivalents thereof are inclusive or open-ended terms thatdo not exclude additional, unrecited elements or method steps. Inaddition, the term “at” when referring to the location or placement ofan element or object means in, near, or by the area or location occupiedby the particular structure or element referred to.

As used herein, the term “proximal” shall refer broadly to the conceptof a nearest portion.

As used herein, the term “distal” shall generally refer to the oppositeof proximal, and thus to the concept of a further portion, or a furthestportion, depending upon the context.

Referring now to FIG. 1, a schematic view is shown of a knowntrochanteric nail 10 in an intramedullary cavity of a femur 12. The nail10 may be a relatively long variety, configured to extend a substantialentire length of the femur 12. One or more proximal anchoring members14, such as bone screws, may be used to anchor a proximal end of thenail 10 within the femur 12, and one or more distal anchoring members 16may be used to anchor a distal end of the nail 10.

FIG. 2 shows a schematic view of another known trochanteric nail 18 inthe intramedullary cavity of a femur 12. The nail 18 may be a relativelyshort variety, configured to extend only a partial length of the femur12. One or more proximal anchoring members 14 a, such as bone screws,may be used to anchor a proximal end of the nail 18 within the femur 12,and one or more distal anchoring members 16 a may be used to anchor adistal end of the nail 18.

Referring now to FIGS. 3-4 schematic views are shown of a trochantericnail 20 in accordance with the principles of the present disclosure. Itis to be understood that the term “nail” as used here refers to aconnective orthopedic nail implant, including but not limited to atrochanteric nail for use in a femur, as well as any other connectiveimplant device suitable for use in any bone of interest. The nail 20 isdepicted in the intramedullary cavity of a femur 12. It will beunderstood that the nail 20 may be useful in other types of bones inaddition to femurs, in accordance with the principles of the presentdisclosure. It will be understood that an embodiment of the presentdisclosure may include the nail 20 configured to extend substantially anentire length of the bone. For example, as used herein, the phrase“substantial entire length” of a bone shall be construed to meanapproximately seven-five percent of the length of the bone or more, forexample, eighty percent of the length, or eight-five percent, or ninetypercent, or ninety-five percent, or 99.9%, or any amount in between anyof those. More specifically, one embodiment of the present disclosuremay be configured to extend more than ninety percent of the length ofthe bone. It will be understood; however, that other embodiments of thenail may be configured to extend different lengths with respect to thebone.

One or more proximal anchoring members 21 may be used to anchor the nail20 in the femur 12. It will be understood that the anchoring members 21may be bone screws or any other suitable variety of fastening mechanismknown in the art for use with trochanteric nails. Accordingly, theshape, size, and configuration of the anchoring members 21 may varywithin the scope of the present disclosure. In addition, as illustratedin FIG. 4, a distal anchoring member 25 can be used to anchor the nail20 in the femur.

Referring now to FIG. 5, a break-away side view is shown of oneembodiment of the nail 20 in accordance with the principles of thepresent disclosure. The nail 20 may include an elongate body 22 having alongitudinal axis 24 extending between a proximal end 26 and a distalend 28. The body 22 may include a head portion 30 and a stem portion 32located between the distal end 28 and a proximal end 26. With the headportion 30 being closer to the proximal end 26 and the stem portion 32being closer to the distal end 28. The body 22 may also include atransition portion 34 between the head portion 30 and the stem portion32. The transition portion 34 may include a cross-sectional taper from alarger diameter adjacent the head portion 30 to a smaller diameteradjacent the stem portion 32. Accordingly, the head portion 30 mayinclude a diameter that may be larger than the stem portion 32.

The nail 20 may be viewed as including three areas or regions, a distalarea 20 a, a medial area 20 b, and a proximal area 20 c. The distal area20 a is that area of the nail 20 located nearby or adjacent to thedistal end 28. The proximal area 20 c is that area of the nail 20located nearby or adjacent to the proximal end 26. The medial area 20 bis that area of the nail 20 located between the distal and proximalareas 20 a, 20 c. Typically, the stem portion 32 encompasses the medialarea 20 b and distal area 20 a, with the head portion 30 located in theproximal area 20 c. In one embodiment, the areas are sized such thateach of the respective areas 20 a, 20 b, 20 c represents one-third (⅓)of the overall length of the elongate body 22. The size or length of therespective areas in relation to one another may vary depending upon theoverall length of the elongate body 22 of the nail 20. For example, asthe overall length of the elongate body 22 of the nail 20 increases, theoverall increase in length typically occurs in the medial area 20 b,whereby the medial area 20 b may occupy more than one-half (½) of theoverall length of the elongate body 22 of the nail 20.

A fitting 36 may be disposed on the head portion 30 at the proximal end26. The fitting 36 may be configured for receiving a tool (not shown)for manipulating the nail 20, or for attaching an alignment guide orjig. The head portion 30 may also include one or more openings 38. Theopenings 38 extend across the longitudinal axis 24 for receivinganchoring members, such as bone screws, to anchor the nail 20 in a bone.The openings 38 extend across the longitudinal axis 24 at an angle of90° or less.

The stem portion 32 may include a first opening 42 formed in the distalarea 20 a of the stem portion 32 near the distal end 28 in a directiontransverse to the longitudinal axis 24. The first opening 42 maycomprise an oblong cross-section to allow movement of an anchoringmember 25 therein. A second opening 44 may also be formed in the distalarea 20 a near the distal end 28 of the body 22. The second opening 44may include a round cross-sectional shape for receiving an anchoringmember 25. While shown extending across the longitudinal axis 24 in adirection transverse the longitudinal axis 24, the openings 42, 44 mayextend across the longitudinal axis 24 at an angle of 90° or less. Itwill be understood that other quantities of openings formed in thedistal area 20 a of the stem portion 32, or an embodiment may include noopenings in the distal area 20 a of the stem portion 32 remain withinthe scope of the present disclosure.

As disclosed herein, the stem portion 32 also includes an intermediateopening 50 located in the medial area 20 b of the nail 20. Theintermediate opening 50 is disposed between the distal end 28 and thehead portion 30. The intermediate opening 50 configured for receiving ananchoring member 23. When the nail 20 includes openings in the distalarea 20 a, the intermediate opening 50 is spaced from and locatedbetween the openings and the head portion 30. As illustrated, theintermediate opening may also extend in a direction transverse to thelongitudinal axis 24, or it may extend across the longitudinal axis 24at an angle less than 90°. Accordingly, the nail 20 may be configuredsuch that when the intermediate opening 50 receives an anchoring member,the distal area 20 a of the nail 20 may remain free from anchoringmembers. For example, one embodiment of the nail may include a singleintermediate opening 50 located in the stem portion 32 in an uppertwo-thirds (⅔) of the body 22, such that when an anchoring member isinstalled in the intermediate opening 50, a lower third (⅓) of the nail20 remains free from an anchoring member. As used herein, the term“upper” is associated with the proximal end 26 of nail 20 while “lower”is associated with the distal end 28.

Another embodiment may include a nail 20 having an intermediate opening50 in the stem portion 32 in the upper one-half (½) portion of the body22, such that when an anchoring member is installed in the intermediateopening 50, a lower one-half (½) of the nail 20 remains free from ananchoring member. Yet another embodiment may include a nail 20 having anintermediate opening 50 in the stem portion 32 in an upper one-third (⅓)of the body 22, such that when an anchoring member is installed in theintermediate opening 50, a lower two-thirds (⅔) of the nail 20 remainsfree from an anchoring member. Also, as illustrated in FIG. 4, anotherembodiment contemplates installing an anchor member in both theintermediate opening and at least one of the openings in the distalarea.

One embodiment of the nail 20 may include a through-bore 45 extendingfrom the proximal end 26 to the distal end 28 along the longitudinalaxis 24. Also, a taper 46 may be positioned toward the distal end 28 ofthe stem portion 32. The taper 46 may facilitate insertion of the nail20 in a bone canal. Moreover, one embodiment of the nail 20 may includea bend 48 (see FIG. 8) enabling the nail 20 to align with a particularbone more closely. However, it will be understood that some embodimentsof the nail 20 may be provided with a bend in a different direction, asshown in FIG. 11, for example, and that other embodiments of the nail 20may be provided without a bend.

One feature of the present disclosure may include a nail system fortreating bone fractures in which the nail system includes a plurality ofnails 20 having different lengths. Wherein the length is typicallymeasured from the proximate end to the distal end. For example, thenails 20 may be provided in lengths of 30, 33, 36, 39, 42, and 48centimeters. However, it will be understood that nails 20 of variousdifferent lengths may be utilized within the scope of the presentdisclosure. Each of the nails 20 may include an intermediate opening 50spaced a uniform distance from the proximal end 26 such that the sametargeting jig (not shown) may be used to install an anchoring member inthe intermediate opening 50. This may be helpful in avoiding therequirement to install an anchoring member using the “freehand” method,wherein a surgeon installs the anchoring member without the assistanceof an instrument such as a targeting jig. One embodiment of the presentdisclosure may include a plurality of nails 20, each having theintermediate opening 50 formed approximately 15.5 centimeters from theproximal end 26. It will be understood; however, that other embodimentsmay include the intermediate opening 50 positioned at differentdistances from the proximal end 26.

A feature of the present disclosure is that the nail 20 may be versatilefor use in a traditional manner, as shown in FIG. 1, in which distalanchoring members may be installed in the bone. Alternatively, the nail20 may be used without anchoring members in the distal area 20 a of thenail 20, as shown in FIG. 3.

In use, the nail 20 may be installed in the intramedullary canal of abone, such as a femur 12. The nail 20 may extend a substantially entirelength of the femur 12. One or more anchor members 21 may be installedin the openings 38 in the head portion 30. An anchor member 23 may beinstalled in the intermediate opening 50. It will be understood that atargeting jig may be used to position the anchor member 23 in theintermediate opening 50, since the intermediate opening 50 may belocated closer to the proximal end 26 of the nail 20 than are theopenings in the distal area 20 a of some nails 20. The portion of thenail 20 from the intermediate opening 50 to the distal end 28 may remainfree from anchoring members.

It will be appreciated that the nail 20 may be formed of any knownmaterial capable of providing suitable strength and durabilitycharacteristics, as well as allowing for compatibility with the bone inwhich it is to be installed.

Referring to FIG. 10, a break-away top view is shown of an alternativeembodiment nail 20 a. It will be understood that the nail 20 a may beformed similar to the nail 20, except the nail 20 a may be configured tobe received in a different bone, such as a left femur. Accordingly, abend 48 a may be arranged to allow the nail 20 a to correspond to adifferent bone.

Those having ordinary skill in the relevant art will appreciate theadvantages provided by the features of the present disclosure. Forexample, it is a feature of the present disclosure to provide atrochanteric nail that is simple in design and manufacture. Anotherfeature of the present disclosure is to provide such a trochanteric nailthat may provide enhanced stability by filling substantially an entirebone canal. It is a further feature of the present disclosure, inaccordance with one aspect thereof, to provide a nail that may beconfigured to reduce “pendulum” micro-motion and thereby reduceloosening of anchoring members. It is another feature of the presentdisclosure to provide a nail that may reduce the risk of bone fracturesbelow the nail as may occur in instances where short nails are used. Itis an additional feature of the present disclosure to provide a nailhaving an additional point of fixation that may be configured to spanthe isthmus of a bone canal. It is a further feature of the presentdisclosure to provide a nail with increased rigidity by decreasing thedistance of the anchoring members from the proximal end of the nail. Itis a further feature of the present disclosure to provide a nail thatmay allow a distal-most anchoring member to be installed using atargeting jig rather than a freehand approach. It is another feature ofthe present disclosure to provide a nail that may allow a distal portionof the nail to be free from anchoring members. It is an additionalfeature of the present disclosure, to provide a nail system in which aplurality of nails are provided having different lengths, and anintermediate opening may be provided at a uniform distance from theproximal end such that anchoring members may be installed in theintermediate openings using the same targeting jig.

In the foregoing Detailed Description, various features of the presentdisclosure are grouped together in a single embodiment for the purposeof streamlining the disclosure. This method of disclosure is not to beinterpreted as reflecting an intention that the claimed disclosurerequires more features than are expressly recited in each claim. Rather,as the following claims reflect, inventive aspects lie in less than allfeatures of a single foregoing disclosed embodiment. Thus, the followingclaims are hereby incorporated into this Detailed Description of theDisclosure by this reference, with each claim standing on its own as aseparate embodiment of the present disclosure.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. Such variations arenot to be regarded as a departure from the spirit and scope of theinvention.

What is claimed is:
 1. A method of treating a fracture in a boneincludes the steps of: providing a nail having a longitudinal axis, aproximal end and a distal end, the nail including a head portion and astem portion, and a transition portion between the head portion and thestem portion, wherein at least one opening extending transverse thelongitudinal axis is formed in the head portion, and an intermediateopening extending transverse the longitudinal axis is formed in the stemportion; inserting the nail, including the head portion into a bonecanal wherein the nail extends substantially the entire length of thebone canal; inserting a first anchoring member into the at least oneopening in the head portion; inserting a second anchoring member intothe intermediate opening in the stem portion; and maintaining at least alower third of the nail free from an anchoring member.
 2. The method oftreating a fracture in a bone as set forth in claim 1, including thestep of maintaining at least a lower half of the nail free from ananchoring member.
 3. The method of treating a fracture in a bone as setforth in claim 1, including the step of maintaining at least a lowertwo-thirds of the nail free from an anchoring member.
 4. The method oftreating a fracture in a bone as set forth in claim 1, including thestep of using a targeting jig to insert the second anchoring member intothe intermediate opening in the stem portion.
 5. The method of treatinga fracture in a bone as set forth in claim 4, including the step ofusing the same targeting jig to install the first anchoring member intothe opening in the head portion and the second anchoring member into theintermediate opening in the stem portion.
 6. A nail for treating afracture in a bone comprising: an elongate body sized and configured toextend a substantial entire length of the bone, the elongate body havinga longitudinal axis and extending between a proximal end and a distalend, wherein the elongate body includes a head portion, a transitionportion, and a stem portion, said head portion closer to the proximalend and the stem portion closer to the distal end with the transitionportion located between and separating said head portion and the stemportion, said head portion having a longitudinal axis and the stemportion having a longitudinal axis skewed with respect to thelongitudinal axis of the head portion; wherein at least one opening isformed in the head portion and the stem portion free of openings nearsaid distal end and an intermediate opening is formed in the stemportion between said at least one opening formed in the head portion andsaid distal end with the intermediate opening located in an uppertwo-thirds of said elongate body; and wherein the head portion has across-sectional configuration and the stem portion has a cross-sectionalconfiguration wherein the cross-sectional configuration of the headportion adjacent the opening in the head portion differs in size fromthe cross-sectional configuration of the stem portion adjacent theintermediate opening in the stem portion.
 7. A nail for treating afracture in a bone as set forth in claim 6 wherein the transitionportion includes a longitudinal axis common with the longitudinal axisof the head portion.
 8. A nail for treating a fracture in a bonecomprising: an elongate body configured to extend a substantial entirelength of the bone, the elongate body having a longitudinal axis andextending between a proximal end and a distal end, wherein said elongatebody includes a distal area, a medial area, and a proximal area; saidelongate body including a transition portion located in said medialarea; a taper at the distal end; a proximal opening in the proximal areaof the nail; a bend in the medial area of said elongate body; anelongate body having a constant cross-section between the transitionportion and the taper; and the distal area free of openings.
 9. A nailfor treating a fracture in a bone as set forth in claim 8 wherein theproximal area has a circular cross-sectional configuration having adiameter and the constant cross-section of the elongate body between thetransition portion and the taper has a circular cross-sectionalconfiguration having a diameter wherein the diameter of the proximalarea is greater than the diameter of the elongate body between thetransition portion and the taper.